Free Handouts, Posters & Teaching Graphics

Since we have made the hyoid bone the celebrity of swallowing physiology, we should at least understand it. The hyoid bone is not a fan of other bones: it is the only bone in the human body that does not directly articulate with or connect to another bone. It is also known as the “tongue bone.”

It has more connections to a wider variety of external structures than any other bone, including the larynx, jaw, tongue, pharynx, skull, sternum, and scapula (shoulder blade). Given all of its connections to surrounding structures, it lives in a muscular throne.

Think of it as a royal puppet. Its movement indicates which strings—muscles—are influencing its direction and position in the neck. For example, if it moves toward the jaw, then the suprahyoid, submental, and floor-of-mouth muscles (mylohyoid, geniohyoid, and anterior belly of the digastrics) are contracting. If it moves toward the sternum, then the infrahyoid muscles (sternohyoid and omohyoid) are moving it.

It moves during speech, swallowing, coughing, yawning, and almost all behaviors within the head and/or neck.

During swallowing it follows an upward-forward, boomerang-like arc. The extent of this excursion is quite variable in normal swallowing (Molfenter et al., 2011). Hyoid forward movement ranges from 8 to 18 mm, and hyoid upward movement ranges from 6 to 25 mm.

Clinical relevance: it is an important muscular attachment for many structures in the head and neck and is therefore involved in many head-and-neck functions. Expert understanding of swallowing physiology involves extrapolating hyoid movement to infer the muscle groups influencing its direction.

A rudimentary and misguided interpretation labels hyoid movement normal or abnormal without understanding why it moved, what normal is, or whether the movement affected the swallow—and uses palpation alone to guess at adequate hyoid function. Studies show that clinicians may identify “abnormal” hyoid movement when the hyoid is moving within normal ranges (Brates et al., 2019).

The Dysphagia Therapy handout explains traditional postures and maneuvers used as either compensatory strategies or rehabilitative techniques. Motor learning and neuroplasticity principles are highlighted to differentiate between treatments that do not challenge the patient—reducing disability—versus those that challenge the swallowing impairment with the goal of restoring swallowing function.

Links to relevant research literature and video examples are included. The handout is sponsored by STEP Community and Swallowing Wellness.